Gluten

In the August 2009 Scientific American, there is a fascinating article on coeliac disease and its relevance for understanding other auto-immune disorders.

The triad of environmental triggers, susceptibility genes and a gut abnormality suggests new possibilities around understanding RA, MS, IBD and diabetes In North America about 1 in 133 persons have CD.

Consider the nutrient deficiencies in so many people!! This article affirms the mechanisms of leaky gut. The tissue transglutaminase released by intestinal cells in CD, attaches to the undigested gluten and modifies the peptides greatly increasing binding to HLA DQ2 or DQ8 proteins.

The antigen presenting cells (dendritic cells and macrophages) then send the processed antigen to T cells which release the cytokines of importance. The B cells recognize the transglutaminase and make the antibodies to it.

The author, Professor Alessio Fasano , from U of Maryland Centre for studying mucosal biology and Coeliac disease, discovered a bacterial toxin that dissembled the tight junctions between epithelial cells in the small intestine, and research revealed a protein (zonulin) in human beings that increases this permeability. They then discovered that in many auto-immune diseases, including CD, RA, type 1 diabetes, MS and IBDs, also exhibit increased intestinal permeability! In many of these the zonulin was indeed raised!

This may be one of the reasons why persons other than those with classic CD have gluten intolerance! Some may have other protein intolerances. There is a magnificent diagram in the article!

One therapeutic option is to administer enough oral digestive enzymes to digest the offending exogenous antigen. A zonulin inhibitor called Larazotide has already undergone testing! It reversed the gluten induced intestinal barrier disorder! There are strong grounds to suggest that infants should not be given gluten containing foods in their first year, but with a history of family histories of auto-immune disorders perhaps this should be much longer!